MS-2014-01797_0001.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426.4191 ti Phone
R� (402) 426 -4195 - FAX
MS- 2014- 01797 h 01 a' www.blairnebraska.org
07131/2014' MLSC Residential July 31, 2014
LOCATIONOFIMPROVEMENT: 934 N 18th Ave, Blair, NE 68008
q 'ARCHITECT:
r GENERAL McKinnis Roofing & Sheet Metal
r, OWNER. Michael S And Roxanne R Williamsen CONTRACTOR:
r ,
f , 1645 1st St
934 N 18th Ave Blair, NE 68008
IF
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 07/3012016
934N18thAve- 140731 -2014 Storm Damage ESTIMATED COMP DATE 12/31/2014
DESCRIPTION OF WORK
Roof, gutters, window wraps
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED. NA
I
1. No work will be started before a permit is ISSUED AND POSTED.
2. For commercial permits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic system.
4. The undersigned owner or agent understands and acknowledges this building permit application does not constitute issuance of
this building permit. It is further understood that construction covered by this permit application shall not be commenced until a
copy of a permit signed by the Building Inspector is issued.
5. The undersigned owner or agent agrees to perform the proposed work in accordance with the specifications set forth above and
in accordance with the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or without the intention of the undersigned or any alteration or change from this application without approval of the
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based oil the approval of this
appli tiara.
Signature of Appl ant Date